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Rhodotorula glutinis fungemia successfully treated with fluconazole: report of two cases

2006; Elsevier BV; Volume: 11; Issue: 2 Linguagem: Inglês

10.1016/j.ijid.2006.02.004

1878-3511

Diamantis P. Kofteridis, Elpis Mantadakis, Athanassia Christidou, George Samonis,

Bacterial Identification and Susceptibility Testing

Although serious infections due to Rhodotorula spp in humans are rare, septicemia, endocarditis, meningitis, ventriculitis, peritonitis, keratitis, endophthalmitis, dacryocystitis, and pneumonia have been reported.1Rusthoven J.J. Feld R. Tuffnell P.G. Systemic infection by Rhodotorula spp in the immunocompromised host.J Infect. 1984; 8: 241-246Abstract Full Text PDF PubMed Scopus (47) Google Scholar, 2Anatoliotaki M. Mantadakis E. Galanakis E. Samonis G. Rhodotorula species fungemia: a threat to the immunocompromised host.Clin Lab. 2003; 49: 49-55PubMed Google Scholar, 3Shelburne P.F. Carey R.J. Rhodotorula fungemia complicating staphylococcal endocarditis.JAMA. 1962; 180: 38-42Crossref PubMed Scopus (26) Google Scholar, 4Naveh Y. Friedman A. Merzbach D. Hashman N. Endocarditis caused by Rhodotorula successfully treated with 5-fluorocytosine.Br Heart J. 1975; 37: 101-104Crossref PubMed Scopus (37) Google Scholar Immunocompromised individuals with central venous catheters are at greatest risk.5Kiehn T.E. Gorey E. Brown A.E. Edwards F.F. Armstrong D. Sepsis due to Rhodotorula related to use of indwelling central venous catheters.Clin Infect Dis. 1992; 14: 841-846Crossref PubMed Scopus (87) Google Scholar Few reports describe Rhodotorula spp infections in immunocompetent individuals. We report herein two cases of Rhodotorula glutinis fungemia in otherwise healthy men. In both cases the isolates were identified by the API 20C AUX system (bioMerieux, Marcy l’Etoile, France) and the identification was confirmed by the YST card in Vitek 2 system (bioMerieux, Marcy l’Etoile, France). Case 1. A 64-year-old man was admitted because of altered consciousness and disorientation. Blood cultures taken on admission yielded methicillin-resistant Staphylococcus aureus; treatment with vancomycin was started. On day 12 of hospitalization a new set of blood cultures yielded Acinetobacter baumannii which was treated with imipenem for 10 days. On day 25 of hospitalization he developed a new fever and two sets of blood cultures yielded Rhodotorula glutinis sensitive to fluconazole (MIC 1.5 μg/mL) and resistant to 5-fluorocytosine (MIC >32 μg/mL) by E-test (AB Biodisk, Solna, Sweden). The patient was commenced on fluconazole 400 mg per day intravenously. The blood cultures became negative after 48 hours. He successfully completed one month of oral fluconazole. Case 2. A 65-year-old man was admitted with community-acquired pneumonia. He was initially treated with clarithromycin and cefuroxime. On day 10 of hospitalization, the antibiotics were empirically switched to intravenous piperacillin/tazobactam and ciprofloxacin due to a new fever. Five days later due to persistent fever with negative blood cultures, the antibiotics were again changed to a combination of imipenem and ciprofloxacin. New blood cultures grew R. glutinis sensitive to fluconazole (MIC 1.5 μg/mL) and resistant to 5-fluorocytosine (MIC >32 μg/mL). Intravenous fluconazole 400 mg daily was given and all antimicrobials were discontinued. The patient became afebrile within 24 hours. He successfully completed four weeks of oral fluconazole. The previous use of broad-spectrum antibiotics was the only predisposing factor for fungemia in our patients. The fungi were susceptible to fluconazole and both patients were successfully treated with this drug. Most isolates of R. glutinis are susceptible to amphotericin B, ketoconazole, itraconazole, and 5-fluorocytosine, and resistant to fluconazole.6Galan-Sanchez F. Garcia-Martos P. Rodriguez-Ramos C. Marin-Casanova P. Mira-Gutierrez J. Microbiological characteristics and susceptibility patterns of strains of Rhodotorula isolated from clinical samples.Mycopathologia. 1999; 145: 109-112Crossref PubMed Scopus (52) Google Scholar, 7Lui A.Y. Turett G.S. Karter D.L. Bellman P.C. Kislak J.W. Amphotericin B lipid complex therapy in an AIDS patient with Rhodotorula rubra fungemia.Clin Infect Dis. 1998; 27: 892-893Crossref PubMed Scopus (26) Google Scholar, 8Marinova I. Szabadosova V. Brandeburova O. Krcmery Jr., V. Rhodotorula spp fungemia in an immunocompromised boy after neurosurgery successfully treated with miconazole and 5-flucytosine: case report and review of the literature.Chemotherapy. 1994; 40: 287-289Crossref PubMed Scopus (24) Google Scholar, 9Zaas A.K. Boyce M. Schell W. Lodge B.A. Miller J.L. Perfect J.R. Risk of fungemia due to Rhodotorula and antifungal susceptibility testing of Rhodotorula isolates.J Clin Microbiol. 2003; 41: 5233-5235Crossref PubMed Scopus (106) Google Scholar, 10Preney L. Theraud M. Guiguen C. Gangneux J.P. Experimental evaluation of antifungal and antiseptic agents against Rhodotorula spp.Mycoses. 2003; 46: 492-495Crossref PubMed Scopus (16) Google Scholar One previous report exists of catheter-related sepsis due to R. glutinis in a cancer patient that was successfully treated with fluconazole and catheter removal.7Lui A.Y. Turett G.S. Karter D.L. Bellman P.C. Kislak J.W. Amphotericin B lipid complex therapy in an AIDS patient with Rhodotorula rubra fungemia.Clin Infect Dis. 1998; 27: 892-893Crossref PubMed Scopus (26) Google Scholar This report supports the possible utility of in vitro fungal susceptibility testing by E-test, although prospective studies will prove if susceptibility testing of Rhodotorula isolates by E-test correlates with clinical outcome. Conflict of interest: No conflict of interest to declare.